Features

6

Commentary. Rear Adm. Stephen A. Turcotte, 

USN, urges returning servicemembers to play it 

safe while on leave. 

Medical Care. Active duty and Reserve combat 

medics care for wounded Iraqis and servicemembers alike.

Open for Business. Tennessee Guard members 

open medical staging facility at Baghdad International Airport.

AE Revolution. Patient support pallets revolutionize Air Mobility Command’s air evacuation 

mission.

Now Available. The Department of Veterans Affairs’ comprehensive benefits guide is now on 

the World Wide Web.

Research Complete. Four research studies 

about Gulf War illnesses have been completed.

Stressed Out. DoD mental health experts say 

combat stress symptoms may vary among returning servicemembers.

2003

8

summer

Tracking Patients. Fleet Hospital Three personnel 

test new medical tracking system 

for local injured sailors and Marines in Iraq.

Family Support. The American Legion’s 

Family Support Network lends a helping hand 

to military families during deployments.

War Talk. Female F-15E weapons system 

officer speaks out about her experience 

flying missions over Iraq.

Technology Advances. Teleradiology may 

prove to be the answer to shortfall of military 

radiologists.

Medical Workstation. The Joint Medical Workstation allows commanders to monitor 

the physical health of their troops in the field.

No Bones. It is estimated that 44 million Americans are at risk for developing 8 osteoporosis, which can be prevented.

News from Around the World 3 

DoD Complies With New HIPPA Privacy Standards. 

Post-Deployment Health Assessments Are Enhanced.

Officials Improve Speed Of Mail To Iraq.

Ask Our Doctors 5

U.S. Army Surgeon General Investigates Possible 

Cases of Pneumonia Among Troops In Iraq.

Vaccines, Drugs & Herbs 5

Watery, Itchy Eyes May Be Signs Of Allergies.

Gulf War Update 9

DoD Releases Final Pesticide Environmental Report.

Health Beat 17

Put Your Foot Down In The Right Shoe.

Resource Guide 20

On the Cover

7

9 In Every Issue

Soldiers from Charlie Company, 3rd Forward Support Battalion Fort Stewart, Ga., 

remove three wounded Iraqi civilians from an 

ambulance. 

U.S. Army photo by Sgt. Keith D. McGrew

1st Lt. Julie Ayres, left, and Capt. Mary 

Melfi and Capt. Tally Parham walk down 

the flightline at a forward-deployed air base 

in the Middle East on May 3. The three 

officers are assigned to the 379th Air 

Expeditionary Wing and flew combat 

missions during Operation Iraqi Freedom. 

U.S. Air Force photo by Staff Sgt. Derrick C. Goode
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

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guestcommentary

mission. 

Learn From history 

Traffic death and recreational fatality rates plummeted 

during Operation Desert Storm, then increased 

dramatically during the seven months following the war. 

The traffic-death rate during Operation Iraqi Freedom has 

fallen to zero and is currently the second longest personal 

motor vehicle-fatality-free period on record. 

Don’t let history repeat itself. Bear in mind that trafficmishap rates are typically higher in the summer months, 

when most of our sailors and Marines will be returning.

We can prevent needless fatalities with good risk 

management, responsible decisions and common sense. 

Now is the time to use all our programs to ensure our 

returning sailors and Marines are well prepared to 

resume their roles in the family and the workplace. 

Stay focused, stay alert, and stay alive. 

Your loved ones, your Navy and Marine Corps and your 

nation need you as we reset our forces and remain ready to 

accomplish our mission. 

Lean forward, be safe, have fun. ■

Rear Adm. Stephen A. Turcotte, USN, is the 48th Commander 

of the Naval Safety Center located in Norfolk, Va. 

Returning Safely From 

Operation Iraqi Freedom

By Rear Adm Stephen A. Turcotte

Commander, Naval Safety Center

he Navy/Marine Corps team has performed flawlessly 

in supporting the global war on terrorism overseas. 

Although much work remains to be done in Iraq, 

sailors and Marines will soon begin returning home. 

Having overcome the hazards of combat, they will 

now face additional challenges. We must maintain our 

unprecedented level of readiness and sustain this posture 

over the long term. 

As always, staying ready means staying safe. It took 

considerable effort to deploy our agile, flexible and 

responsive fleet for such an extended period. We must 

apply the same amount of effort to get them back both 

safe and prepared. Well-deserved celebrations and joyous 

reunions await, but so do the temptations and risks that 

frequently claim too many of our people. Specifically, we 

must place renewed emphasis on the following issues.

Drinking And Driving

The message here is simple. If you are going to drink, 

don’t drive. Either stay put, have a designated driver, or 

call a cab. Make a plan before going out on the town 

and ensure you and your shipmates stick to the plan. 

Drinking too much can be deadly, whether you are behind 

the wheel of a vehicle, walking across a busy street, or 

stumbling around on a motel balcony.

Fatigue

Everyone wants to hurry home to see his or her family. 

With a little foresight, you can reach your happy reunion 

without any accidents on the way. Be conservative in how 

far you plan to drive each day. Drive during the daytime 

and have a driving partner. Take plenty of breaks. Rest or 

sleep when your body or buddy tells you to. Plan to leave 

early enough to allow ample travel time both to and from 

your destination.

Staying Safe On Liberty

Use the buddy system, and keep an eye out for one 

another. Speak up and take charge if situations develop 

that require intervention. If you are currently in a 

leadership role, set the example and make it clear that you 

expect everyone to return from liberty healthy and ready 

to continue making their invaluable contributions to the 

Editor’s Note: This message was sent to all Navy and Marine 

Corps shore and afloat activities in April. While the message 

was directed primarily at sailors and Marines, the information 

it provides is worth repeating for all. The Naval Safety Center 

offers a variety of safety tips and other informational materials on 

its Web site at http://www.safetycenter.navy.mil/default.htm
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

U.S. Air Force photo by Tech. Sgt. Dave Buttner

Tech. Sgt. Jeff McElhoe (left) guides the crane operator to place an A-10 Thunderbolt 

II fuselage in position so the shipping cradle can be moved underneath. The aircraft 

received severe battle damage during a combat mission over Iraq in April and will be 

shipped back to the United States for repair. 

Need A Lift?

ASHINGTON — Assistant Secretary 

of Defense for Health Affairs William 

Winkenwerder Jr. announced that 

all military medical facilities have 

implemented the privacy rule of the 

Health Insurance Portability and 

Accountability Act (HIPAA) of 1996. 

With a directed start date of April 14, 

2003, the new rule creates standard 

safeguards to protect the privacy and 

confidentiality of personal health care 

information.

Winkenwerder points out that, “The 

Military Health System has always 

had privacy standards in place to limit 

unauthorized access and disclosure 

of personal health information; this 

new rule heightens awareness, raises 

the level of oversight and provides a 

standard set of guidelines to protect the 

privacy of all patients.”

As required by the new rule, DoD 

has mailed approximately five million 

military health system notices of 

privacy practices. The notices have 

gone to every beneficiary enrolled 

in the Defense Enrollment Eligibility 

Reporting System (DEERS).

The new privacy legislation requires 

that health information be disclosed 

only for treatment, payment, and 

some health care operations such as 

scheduling appointments and billing 

patients. Health information will 

not be shared with outside sources 

for marketing, research or any other 

purpose without the beneficiary’s 

written consent.

Each military treatment facility has 

an assigned, trained privacy officer 

available to respond to any questions 

or concerns that beneficiaries may have 

regarding the new privacy rules. The 

privacy officers also serve as patient 

DoD Complies with 

New HIPAA Privacy 

Standards

— Continued on Page 4
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

news from around the world

advocates, ensuring that personal 

health information maintained by 

the military treatment facility 

remains protected yet accessible to 

beneficiaries and their providers.

A copy of the Military Health System 

Notice of Privacy Practices is available 

on the TRICARE Web site 

for sponsors and family members to 

download; copies are also available 

for distribution at each Defense 

Department military treatment facility. 

Additional information on HIPAA, 

Tricare and the new privacy standards 

is available on the TRICARE Web site at 

http://www.tricare.osd.mil/hipaa.

Post-Deployment Health 

Assessments Enhanced

WASHINGTON – Thousands of 

active duty and Reserve U.S. servicemembers deployed overseas 

for Operation Iraqi Freedom will 

undergo an enhanced post-deployment 

health assessment process. 

The new health evaluation process 

was approved mid-April and is being 

implemented now to provide added 

safeguards for the health of deployed 

servicemembers, said Dr. William 

Winkenwerder, assistant secretary 

of defense for health affairs.

The process has been enhanced in 

several ways, Winkenwerder pointed 

out, and it applies to all military who 

have served or are serving in the 

Iraqi Freedom theater.

First, he said, a new post-deployment health assessment form asks more 

questions about a service-member’s 

physical and mental health than 

earlier versions and adds queries 

about possible health-threatening 

occupational or environmental 

exposures during deployment. 

Secondly, Winkenwerder continued, 

each servicemember is required to 

undergo a post-deployment health 

assessment face-to-face with a 

military health care provider upon 

redeployment to a demobilization 

site or home station. 

Thirdly, all servicemembers will 

provide a blood sample no later 

than 30 days after arrival at a 

demobilization site or home station, 

Winkenwerder said. The blood serum 

samples, he noted, will be stored in 

the serum repository. They may be 

used in the future to assist in medical 

care of an individual who later becomes 

ill, or to determine the 

extent of some deployment-related 

exposure that is recognized at a later 

date. The samples could also be 

used in the future if medical science 

develops diagnostic capability for 

exposures that may have occurred 

during a deployment. 

He noted that results of all postdeployment medical health assessments 

would be placed 

within servicemembers’ permanent 

medical records. 

DoD, he asserted, has a responsibility 

“to do right” for America’s 

servicemembers. 

“They expose themselves to great 

risk and harm — they perform 

Military Officials Improve 

Speed of Iraq Mail

OPERATION IRAQI FREEDOM -- 

Airman Martin Rygula, an air 

transportation craftsman, takes time 

to write a letter while deployed to Tallil 

Air Base, Iraq, supporting Operation 

Iraqi Freedom. 

U.S. Air Force photo by Staff Sgt. Shane A. Cuomo

News From 

The Front

WASHINGTON —Even in the era of 

e-mail, getting a letter from loved ones 

is important. 

The Military Postal Service Agency 

has received a number of complaints 

about the speed of mail deliveries to and 

from Iraq. The officials are aware of the 

problems and expect changes to ease 

some stumbling blocks. 

The main problem, according to 

agency officials, was that there was no 

mail facility in Iraq. 

“Now there is one at the Baghdad 

International Airport, and we expect 

that will improve service,” said an 

official with the agency. 

In the past, mail from servicemembers 

back to the states went from Baghdad 

to Kuwait, where it was placed on a 

commercial flight to John F. Kennedy 

airport in New York. Mail going to 

Iraq also had to pass through Kuwait. 

Opening the facility in Baghdad will 

speed the process and eliminate the 

Kuwaiti step. 

The military mail official said mail 

clerks are working around the clock to 

eliminate the mail backlog. 

“We’re moving between 30,000 and 

40,000 pounds of mail each day,” he 

said. He estimated the backlog at about 

300,000 pounds of mail. 

Officials are working to address 

problems within Iraq. They said 

servicemembers based outside the 

Baghdad area may find their letters 

are not getting out as quickly as 

expected because clerks are filling up 

trucks with mail before dispatching 

them. They expect that as the country 

becomes safer, the mail will speed up. 

Military postal officials refute the 

rumor in Iraq that says the U.S. Postal 

Service is holding the mail at JFK 

airport. Mail leaving the region takes 16 

hours to get to New York. From there, it 

takes about three or four days to reach 

the recipients. ■

bravely and admirably,” 

Winkenwerder pointed out. 

“We owe it to them to ensure that 

they have a comprehensive health 

assessment before they resume their 

usual sorts of duties,” he concluded. 
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

Q

A

A

ask doc

drugs & herbs

— Continued on Page 12

My doctor prescribed an antihistamine for 

my allergies. I have been taking them for 

about a month or so and they work ok, but 

allergens such as dust, animal dander and 

indoor mold spores. 

My recommendation, always follow up 

with your physician. 

There are numerous first-generation 

antihistamines, and often it takes a couple 

of tries to find the right one for your 

condition and situation. A combination 

of strategies is often used along with 

pharmacological management to provide 

relief of symptoms. Your doctor may 

have told you that the most effective 

way of controlling allergic rhinitis is to 

avoid the allergens. There are numerous 

environmental modifications that can be done around the 

home to reduce your exposure. These include frequent 

vacuuming of carpets, use of dehumidifiers, keeping pets 

Qit causes me to get sleepy during the day. I have 

heard some new non-sedating antihistamines are 

available at the drug store, without a prescription. 

Do you recommend this?

There are several considerations when 

selecting a course of treatment for what I 

am assuming is allergic rhinitis, which 

are cost, sedative properties, flight status, medical can be seasonal or perennial. Examples 

condition and job function.

Allergic rhinitis refers to your body’s response 

to inhaled antigens. Symptoms may include sneezing, 

runny nose, nasal congestion, itchy eyes and post-nasal drip. 

Seasonal allergies are usually caused by pollens and outdoor 

mold spores. Perennial allergies are usually caused by indoor 

vaccines

Recently I’ve heard news reports 

about hundreds of troops getting 

pneumonia, and some have even 

related to one another. 

When the investigation 

is complete, the Army 

will announce the 

teams’ findings and 

recommended actions.

The most common 

cause of pneumonia is 

infection, usually due 

to bacteria or viruses, 

but occasionally 

due to fungi. Many 

different types of 

microorganisms can cause pneumonia, 

and treatment is best guided by 

knowledge of the specific cause. 

Antibiotics can treat infections due to 

bacteria and fungi. No such treatment 

is available for most viruses. So far, 

no single type of infection has been 

found to explain the severe cases 

of pneumonia in Operation Iraqi 

Freedom.

The non-infectious types 

of pneumonia result from the 

inflammation provoked by a chemical 

or irritant that directly damages the 

lung tissue. Treatment is focused on 

supporting the patient’s ability to get 

enough oxygen and on preventing 

complications until the lungs have 

healed themselves. So far, none of 

the cases of severe pneumonia in 

Operation Iraqi Freedom has been 

blamed on toxic 

chemical exposures.

The Army 

investigations are 

intended to determine 

if there are common 

infectious or toxic 

causes for some or all 

of the severe cases of 

pneumonia. These 

cases appear to be 

unrelated to one 

another, and no single 

approach to treatment and prevention 

is obvious. 

The number of cases of pneumonia 

among our servicemembers in 

Iraq is not greater than the number 

that occur each year among U.S. 

servicemembers. Nevertheless, the 

detection of these cases has prompted 

special efforts to determine if there 

is a common, preventable cause. If a 

pattern can be detected in these cases, 

then it is possible that future cases 

of pneumonia can be prevented and 

treatments can be improved.

If anyone has health concerns 

possibily resulting from a recent 

deployment or has questions about his 

or her health should see their health 

care provider. ■

The term pneumonia is used 

to describe inflammation of 

the parts of the lung that allow us 

to take up oxygen from the air we 

breathe. Severe cases, pneumonia can 

prevent absorbing enough oxygen 

into the blood and cause damage to 

other organs. Even with treatment, 

pneumonia sometimes causes in 

death. 

There has been much recent 

publicity about the occurrence 

of pneumonia among U.S. 

servicemembers taking part in 

Operation Iraqi Freedom. Those 

with mild pneumonia are better and 

all but two of the servicemembers 

who developed severe pneumonia 

during Operation Iraqi Freedom 

have recovered due to the care 

they received. Because almost all 

of the severe pneumonia occurred 

among Army personnel, the U.S. 

Army Surgeon General sent special 

investigative teams to Germany and 

to Iraq to see if these cases may be 

died from it. Do you know if this is 

really happening, and what are you 

doing to protect them? 
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

T

he Army forces that led the liberation 

of Iraq in April received a full range of 

medical support from combat medics, 

forward surgical teams, a Mobile Army 

Surgical Hospital, combat support 

hospitals, fixed facilities back in Europe 

and the United States, and detachments 

with a wide variety of allied skills. 

Active and Reserve Components were 

both well represented.

Forward surgical teams were used to 

provide surgical care close to the point 

of injury, before critical patients were 

evacuated to combat support hospitals.

“The surgeries here are aimed 

at saving a life, saving a limb and 

preventing infection,” Maj. Matt 

Vreeland told the San Jose Mercury 

News. “If you can clean out an 

abdominal wound and prevent 

infection, you can save a life.”

“We may not do the definitive 

operation,” said Maj. Rob Bass, a 

general surgeon with a forward 

surgical team. “We stop the casualty 

from bleeding or dying and we 

evacuate them — if they are stable 

enough to do the definitive operation, 

then we’ll definitely do that.”

by jerry harben

editor, the mercury

U.S. Army photo by Staff Sgt. Shama Parker

Spc. Linda Carvallo, a medic with Alpha Company, 11th Engineer Battalion, 3rd Infantry Division, 

examines a local resident with a gunshot wound near the Al Wasity hospital in Baghdad, Iraq, May 

28, 2003. Soldiers from Alpha Company, 11th Engineer Battalion, 3rd Infantry Division, were supporting Task Force Neighborhood. 

After setting up in central Iraq, 

the 212th Mobile Army Surgical 

Hospital saw 300 patients and 

performed 49 surgeries in two 

weeks, as reported in European 

Stars and Stripes.

“This is really busy, and it’s tiring,” 

said Capt. Dale Vegter, a surgical nurse 

in the operating room. “But this is 

what we do.”

At the peak, the hospital had 51 

patients. Some doctors gave up their 

sleeping cots to make way for injured 

soldiers.

The MASH loaded its entire 

hospital into 37 five-ton trucks and 

five Humvees (a type of military light 

truck) and drove for 78 hours, 300 

miles into Iraq to support rapidly 

advancing infantry. They 

set up the hospital during a 

roaring sandstorm.

One medic, Pfc. 

Joseph Dwyer of the 3rd 

Squadron, 7th Cavalry, 

became something of a 

celebrity when a photo of 

him carrying an injured 

Iraqi child appeared in 

newspapers and on Web 

sites around the world. 

Dwyer said the boy had a 

broken leg, and the boy’s 

father brought him to 

the U.S. soldiers after a 

firefight.

“The kid was doing all 

right. I could feel him 

breathing real hard. He 

didn’t cry one bit, and you know he 

was a cute little kid. He was scared, 

though,” Dwyer told USA Today.

Other Army Medical Department 

members labored to detect 

environmental hazards, ensure safe 

food and water and myriad other 

duties.

As active-duty medical personnel 

deployed, Reservists replaced many 

of them in U.S. military facilities. 

Many people at Madigan Army 

Medical Center, Wash., deployed, 

but Raymond Gyger, regional vice 

president of the National Association 

of Uniformed Services, said service 

didn’t miss a beat during the 

personnel changes.

“I know some of the doctors have 

been deployed, but I haven’t heard 

of anything that’s detrimental in any 

way, shape or form. It seems to be 

working smoothly,” Gyger told the 

Tacoma News Tribune.

David R. Nelson, president of 

Sierra Military Health Services Inc., 

the TRICARE contractor for the 

northeastern United States, told 

the Baltimore Sun his company saw 

a dramatic increase in workload 

after troop deployments began. He 

said Sierra’s monthly enrollments 

increased 50 percent as Reserve 

and National Guard members 

were called to active duty. Sierra 

conducted benefit briefings for more 

than 50,000 people. ■

Medics Support 

Operation Iraqi 

Freedom
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

T

by tech sgt. ruby zarzyczny

437th airlift wing public affairs

he 379th Expeditionary Aeromedical 

Evacuation Squadron has opened a 

10-bed mobile medical staging facility 

near the military flightline at Baghdad 

International Airport. Facility workers 

there conduct joint service, coalition and 

civilian air evacuation missions.

In the field, after self-aid and buddy 

care, a patient needing additional 

medical attention goes into a battalion 

aid station or an Army combat support 

hospital. If the injury is serious enough 

the patient comes to the staging facility.

“The [facility] is a staging area for 

patients being evacuated out of the 

theater from Army combat support 

hospitals and into the aeromedical 

evacuation system,” said Maj. Lynne 

Medley, 379th EAES commander 

deployed from the Tennessee Air 

National Guard’s 118th Aeromedical 

Evacuation Squadron in Nashville.

The facility has four flight nurses, 

one medical service corps officer, one 

administration airman, two radio 

operators and seven aeromedical 

evacuation technicians working around 

the clock. They are all Guardsmen 

from the Nashville squadron, and they 

deployed to Baghdad International 

Airport together.

“I love being here,” said Master Sgt. 

Ken Quattlebaum, the 379th EAES 

noncommissioned officer in charge and 

first sergeant. “We’ve been training 

together for this kind of situation 

for two years, and when we got the 

call, they called the whole team and 

deployed us together. We’ve had two 

years to get to know each other, and 

if you were to throw different people 

together, they might not have been able 

to work together as well as we have.”

According to Medley, it is critical for 

the team to work well together because 

it takes all of them to keep the mission 

going.

“About 80 percent of the patient 

movement to the [facility] is mostly 

at night because of the availability of 

planes,” said Medley. “When [Joint 

Patient Movement Requirements Center 

officials at Scott Air Force Base, Ill., 

decide] a patient will move, the [facility 

workers] communicate by secure radio 

to coordinate the patient movement. 

Then we wait to hear the incoming 

choppers. Some of the patients need 

medical attendants to stay with them, 

and we can generate a crew to go with 

the patient and take care of them in 

flight.”

Within the first two weeks, the 

airmen moved 74 litter patients, 169 

ambulatory patients and 15 attendant 

patients.

“When the patients get here we 

check their vital signs, do a physical 

assessment, check and change 

bandages, check IV sites, and check 

to see if they need medications,” said 

Medley.

“Once the patients are stabilized, we 

provide them with showers, toothpaste 

and cooled water, something many 

of the patients coming from the field 

haven’t seen in months,” she said. 

“They can also take a trip into the ‘care 

package’ area ... to select items they 

might need or want.

“We’re also supporting the 

humanitarian side,” said Medley. 

“[People] will bring their patients here 

to stay where it’s cool and readily 

accessible to the flightline.”

The airport has two different areas, 

the military side and the civilian side, 

separated by a distance of about seven 

miles.

“The Iraqi civilians who are 

evacuated through the [facility] are 

put on the planes with the approval of 

the secretary of defense,” said Medley. 

“An Iraqi civilian working with the 

Army was injured in an ambush and 

was evacuated ... recently. Many of 

the patients are evacuated to hospitals 

in Kuwait. The military patients 

are treated in Kuwait or sent on to a 

hospital in Germany.”

The 10-bed facility here averages 

about 20 patients a day, and workers 

provide medical care to the residents 

of tent city while the expeditionary 

medical support teams are in the 

process of standing up.

“We work under stressful situations,” 

said Medley. “We have had [everyone] 

from a critical injury pilot to an injured 

4-month-old baby. We know each other 

well, and that helps us cope with the 

stress.”

“We have the best medical care 

and patient evacuation system in the 

world,” said Quattlebaum. “Someone 

who is out there actually fighting can 

be confident that [he or she] will have 

the best medical treatment in the world, 

and we’re part of that system.”

“The [facility] will be here as long 

as the contingency operation is here,” 

said Medley. “We’re staying until 

September, but we’re prepared to stay 

as long as we’re needed.” ■

U.S. Air Force photo by Tech. Sgt. Ruby Zarzyczny

Senior Master Sgt. Ken Quattlebaum (left) and 2nd Lt. Beverly Groogand (right) carry a wounded 

soldier from a helicopter to an ambulance en route to the mobile aeromedical staging facility. The 379th 

Expeditionary Aeromedical Evacuation Squadron at Baghdad International Airport comprises members 

of the Tennessee Air National Guard’s 118th Aeromedical Evacuation Squadron in Nashville. 

Tennessee Guard 

Opens Baghdad 

Facility 
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

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W

Patient Support Pallets Revolutionize 

Air Evacuation Missions

evacuation concept and development. 

“The PSP allows us to take advantage 

of all our existing airframes.”

Now used on KC-135, KC-10 and 

C-17 airframes, the PSP is built on a 

standard cargo pallet, and provides 

supports for six stretchers or a 

combination of three airline seats and 

three stretchers. Remaining mobility 

aircraft do not need to use the PSP 

because they already have some ability 

to support evacuation missions.

Although the C-17 is designed to 

support AE as a secondary mission, 

and has electrical outlets and oxygen 

sources for patient care, it is only 

configured to carry nine stretchers. The 

PSP allows the C-17 to support larger 

numbers of patient transfers. With 

PSPs, the C-17 can carry a maximum 

of 12 pallets to accommodate up to 72 

patients.

“The retirement of the C-141 in 2006 

has really brought this technology 

to the forefront as a critical need,” 

said Maj. Tami Averett-Brauer, AE 

Allocation Division chief at AMC’s 

Tanker Airlift Control Center. “When 

we started transitioning to the C-17, we 

knew that we would have situations 

that would require us to transport more 

than nine stretchers.” 

In addition to increasing patientcarrying capacity, the PSPs also save 

the Air Force millions of dollars each 

year.

“Purchasing the PSPs is far less 

expensive than the cost of modifying 

the existing fleet of aircraft to support 

needed AE missions,” said AverettBrauer. 

The C-141 has been an AE long-haul 

workhorse for many years. The C-141 

was designed to perform AE missions 

and has a capacity to carry more than 

100 stretchers.

In fall 1999, AMC formed an 

evaluation team to reevaluate the 

wartime requirements for aeromedical 

evacuation. The team’s findings 

showed a need for alternatives to the 

aging fleet of aircraft performing AE 

missions, like the C-141.

From these findings, development of 

the PSP began and, in April 2002, four 

prototype PSPs were sent to Pacific Air 

U.S. Air Force photo

Members of the 775th EAES tend to a patient on a patient 

support pallet. The new patient transport technology can 

be used for aeromedical evacuation on KC-135, KC-10 and 

C-17 airframes.

Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

Forces for weekly operational testing. 

The first delivery of 25 production 

model pallets was made in February of 

this year.

“The pace at which we went from 

drawing board to a prototype is 

phenomenal,” said DeDecker, who is 

currently the deputy commander of 

the 775th Expeditionary Aeromedical 

Evacuation Squadron. “It has been a 

valuable tool in the success of the 

AE mission in Operation Iraqi Freedom. 

The AE system moved 640 battle 

casualties and more than 1,300 other 

patients in the first 35 days of 

the war without the use of dedicated 

aircraft. That is a remarkable 

transformation.” ■

New Online VA Benefits 

Guide Now Available

by 2nd lt. dustin hart

air mobility command public affairs

hen Pfc. Jessica Lynch came home 

from the war on a C-17 Globemaster 

III, she and the 49 other injured 

servicemembers on the flight were able 

to take advantage of a new aeromedical 

evacuation technology.

When that C-17 touched down April 

12 at Andrews AFB, Md., it was one of 

the first times patient support pallets 

were used to return injured troops 

from the battlefield.

According to Air Mobility Command 

officials, the patient support pallets 

are increasing the capability of AMC’s 

aeromedical evacuation mission. 

“The vision of aeromedical 

evacuation is to have the capability to 

perform AE [aeromedical evacuation] 

missions on any Air Force mobility 

aircraft,” said Maj. Lisa DeDecker, 

the AMC branch chief of aeromedical 

T

he Department of Veterans 

Affairs has made its comprehensive benefits guide available 

for free on the Internet.

Federal Benefits for Veterans 

and Dependents, available 

online at http://www.va.gov/

pubaff/fedben/Fedben.pdf, is a 

118-page handbook describing 

benefits provided by the VA and 

an overview of programs and 

services for veterans provided 

by other federal gencies.

VA officials estimate most of 

America’s 25 million veterans 

qualify for at least some VA 

benefits, but many are unaware 

of their entitlements. This 

handbook includes a listing of 

toll-free numbers, Internet 

information resources and 

VA facilities.

The book can be purchased 

through the Government 

Printing Office for $5 for 

U.S.-based customers and $6.25 

for those overseas by calling 

toll-free (866) 512-1800. ■
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

T

W

gulf warupdate

Pesticides Final Environmental 

Exposure Report Released

than 10 veterans sought treatment for pesticide exposure. 

Since publishing the interim report, the directorate has 

received no new information that would have changed its 

conclusion.

Although this is a final report, veterans who have 

information they believe may change this environmental 

report are encouraged to call the toll-free Veterans’ Direct 

Hotline number at (800) 497 - 6261 Monday through 

Friday from 9 a.m. to 9 p.m., Eastern Standard Time. 

Veterans may also write to us via e-mail at special.assistant@

deploymenthealth.osd.mil. 

To read the final Pesticides Environmental 

Exposure Report, go to the GulfLINK Web site at 

http://www.gulflink.osd.mil/pest_final/index.html. ■

New Gulf War Research Presented To Advisory 

results of his Defense Departmentsponsored study of autonomic 

nervous system function in Gulf 

War-era veterans. The autonomic 

nervous system controls many of 

the body’s functions (like breathing) 

automatically, without any conscious 

effort. Using a battery of tests to 

capture the complexities of the 

autonomic nervous system, Sastre’s 

findings indicate that ill veterans 

demonstrate autonomic system 

dysfunction on a broad range of tests.

Results of a just-published VAfunded study by Roberta F. White, 

Ph.D., of Boston University School 

of Medicine and the Boston VA 

Healthcare System Medical Center 

indicated that Gulf War-deployed 

veterans performed “significantly 

worse” on tests of attention, 

visuospatial skills, visual memory 

and mood. Additionally, deployed 

Gulf War veterans who used 

pyridostigmine bromide performed 

worse than their deployed comrades 

who did not use the drug.

John Vogel, Ph.D., of Lawrence 

Livermore Laboratory in California, 

discussed the use of accelerator mass 

spectrometry to detect very low levels 

of pesticides and their effect on the 

brain’s increased absorption of a 

second toxic exposure. The research, 

conducted with animals, was 

sponsored by the National Institute of 

Environmental Health Sciences.

Likewise, undetected low-level 

exposure to sarin nerve gas can 

cause delayed development of brain 

alterations that may be associated 

with memory loss and cognitive 

dysfunction in animals. This study, 

by Rogene Henderson, Ph.D., of 

Lovelace Respiratory Research 

Institute in Albuquerque, N.M., 

advances scientific understanding 

of the long-term effects of exposure 

to chemical weapons.

“This new research has important 

implications, not only for ill veterans, 

but for the development of medical 

defenses to protect future American 

troops and civilians from chemical 

attack,” said committee chairman 

James Binns.

For more information about the 

VA’s Research Advisory Committe, 

for Gulf War Veterans’ Illnesses and 

its committee members, log on 

to its Web site at http://www.va.gov/

RAC-GWVI/. ■

by joan kennedy

he Deployment Health Support Directorate released the final 

version of the Pesticides Environmental Exposure Report 

April 24 about the use of pesticides and the potential for 

overexposure to pesticides by servicemembers during the 

1990-1991 Gulf War. An interim report was published in 

January 2001 to update veterans on what had been learned 

during the course of the investigation.

Analysts from the Deployment Health Support 

Directorate concluded that some troops may have been 

potentially overexposed to pesticides and that this may 

have contributed to some of the unexplained symptoms 

reported by some Gulf War veterans. However, there is 

little documentation that quantifies Gulf War pesticide 

overexposures and veteran interviews suggest that fewer 

ASHINGTON — Research studies 

that challenge the conventional 

wisdom regarding potential links 

between military service during 

the Gulf War and the numerous, 

yet often undiagnosed, illnesses 

reported by many veterans were 

presented recently to the Department 

of Veterans Affairs Research Advisory 

Committee for Gulf War Veterans’ 

Illnesses.

“I am very pleased with the 

progress of the committee and 

ongoing research into the illnesses 

that continue to afflict the brave 

men and women who served so 

well during the Gulf conflict,” said 

Secretary of Veterans Affairs 

Anthony J. Principi. “They haven’t 

given up on their search for answers 

and neither will we.”

Presentations were given on June 

16 by the principal investigators of 

four completed studies that looked 

at the nervous system, cognitive 

function, use of pyridostigmine 

bromide (a drug protecting people 

from nerve agents) and exposure to 

pesticides and nerve gas.

Antonio Sastre, Ph.D., of Midwest 

Research Institute in Kansas City, 

Mo., presented, for the first time, 
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

M

ental health experts don’t know 

what combat stress reactions 

to expect from servicemembers 

returning from the war in Iraq. And 

it’s not just stress reactions from 

actual combat, according to Army Lt. 

Combat Stress Symptoms

by rudi williams

american forces press service 

May Vary Among War Vets 

Col. (Dr.) Elspeth 

Cameron Ritchie. 

Some could be disturbed or 

demoralized by stressors from the 

consequences of combat, such as 

handling remains of civilians, enemy 

soldiers or U.S. and allied personnel. 

Or they could come from dealing with 

POWs, witnessing homes and villages 

destroyed by bombing or a number of 

other battlefield stressors. 

“Combat stress reactions, which 

are psychological reactions to fierce 

combat or operations other than war, 

are both physical and psychological,” 

said Ritchie, program director for 

Department of Defense’s mental 

health policy and women’s issues for 

the Office of the Assistant Secretary of 

Defense for Health Affairs. “Physical 

reactions are things like your hands 

sweating and trembling and your 

heart racing, or a need to go to the 

bathroom a lot.” 

The psychological reactions include 

things like anxiety, hypervigilance, 

difficulty concentrating, or sleeping, 

irritability and sadness. Ritchie 

emphasized that combat stress 

reactions are normal reactions to 

abnormally stressful or traumatic 

situations. 

However, Ritchie, a psychiatrist, 

said, “If these reactions go on for long 

periods of time or get in the way of job 

Soldiers from the 3rd Infantry Division in firing 

positions during an enemy approach on their 

position at objective RAMA, in southern Iraq on 

March 24, 2003. 

U.S. Army photo by Sgt. Igor Paustovski

Soldiers assigned to the 1st Infantry Division, 63 Armored Regiment, 

provide security with support from a M1A1 Abrams Battle Tank and a 

M2A3 Bradley fighting vehicle in Kirkuk, Iraq. 

U.S. Army photo by Private First Class Brandon R. Aird
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

performance, it’s important to get 

treatment.” 

She said soldiers and Marines 

can recognize in themselves or their 

buddies the anxiety and irritability 

that combat stress reactions can 

cause. 

“When things get in the way of 

functioning, that’s when a little more 

help is needed,” Ritchie noted. 

Some people returning from 

Operation Iraqi Freedom may not 

want to talk about what happened 

for a while, she pointed out. 

Signs that a returning 

servicemember is having genuine 

difficulty, she said, could include 

temper outbursts, detachment or 

general difficulty interacting with 

family members. A loved one 

who seems to be 

having a hard 

time adjusting 

to life back at 

home, Ritchie 

said, should be 

encouraged to talk 

to a mental health professional.

The extent of psychological 

reactions servicemembers might 

have from Iraq is unknown.

“What we may see is people who 

are repeatedly seeing the images of 

battle,” Ritchie said. 

She pointed out that there’s a lot 

of overlap between combat stress 

and the stress of everyday activity. 

“What differentiates combat 

stress is usually the intensity of 

what has happened,” the doctor 

noted. “Sometimes you’ll have 

repeated memories and intrusive 

thoughts focusing on what 

happened.” 

Long-term reactions to combat 

stress could lead to post-traumatic 

stress disorder, she noted. “By 

definition, PTSD [Post-Traumatic 

Stress Disorder] is supposed to 

happen a month or more after the 

event,” Ritchie said. “There can 

be some similarities in the 

symptoms of combat stress and 

PTSD — nightmares, insomnia, 

anxiety, numbness, hypervigilance 

and intrusive thoughts.” 

Some servicemembers may have 

only some symptoms of PTSD and 

have difficulty 

functioning. 

Some people 

may be troubled 

by an occasional 

nightmare, which 

isn’t classified as 

PTSD. 

“But other folks might feel that 

they’re so scared that they can’t 

get to work,” she said. “That is a 

problem, and we want them to seek 

treatment.” 

However, she said some of these 

reactions are common; therefore, she 

doesn’t advocate necessarily seeking 

treatment immediately. 

“If the symptoms keep going on, 

such as nightmares night after night, 

they should seek help,” Ritchie said. 

Some health care providers and 

family members make the common 

mistake of encouraging people to 

talk about everything that happened 

before the patient is ready to talk, 

Ritchie noted. 

“I wouldn’t push the returning 

soldier or Marine to talk about what 

happened right away,” she said. 

“But I would be there for him or her 

when he or she is ready to talk.” 

There’s also concern about 

servicemembers’ reactions to 

changed family situations. Those 

returning from the battlefield often 

envision everything at home is 

going to be perfect, like a flawless 

honeymoon. But often things are a 

little bit different, Ritchie said. 

“The kids may have grown. They 

may not respect authority in the 

same way. The spouse may have 

more independence. He or she may 

have needed to make some decisions 

that the soldier or Marine weren’t 

part of. So often there is some 

friction when the soldier or Marine 

gets home. 

“Families should expect a little bit 

of friction so it doesn’t spook them,” 

she said. “So, they don’t think, ‘Oh, 

no! My marriage is coming apart!’ 

It’s part of the reintegration process.” 

Modern day transportation plays 

a major role in creating the problem, 

she noted. 

“In World War I and World War 

II and Korea, people came home by 

ship that took two or three weeks,” 

Ritchie said. “They had a chance to 

get rested and talk to their unit about 

what had happened and prepare to 

reintegrate with the family. 

“Nowadays, people have been on 

the battlefield one day and maybe 

at home or the shopping mall in a 

“Some people returning from 

Operation Iraqi Freedom 

may not want to talk about 

what happened for a while.”

— Continued on Page 16

“But I would be there for 

him or her when he or 

she is ready to talk.”
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

F

and plants out of bedrooms and an 

entire list of things to do and not do. 

Numerous self-help Web sites are 

available with these tips.

In addition to environmental 

modifications, there are numerous 

pharmacological agents to select 

from; administered via oral tablets/

capsules, nasal sprays and eye 

drops. The newer non-sedating oral 

antihistamines are no more effective 

in reducing symptoms of allergies 

than the older antihistamines; 

however, they may be preferential 

because of a better side effect profile 

— specifically, less drowsiness, 

and fewer anticholinergic effects 

such as dry mouth, urine retention, 

constipation and blurred vision. 

Many military jobs are inherently 

risky and require a person to be 

fully alert, awake and aware. This 

unquestionably is the best argument 

for these medications. You didn’t 

indicate your specific job, however, if 

you were in a flying status, there are 

very few medications you could take 

and still fly. If this is the case, discuss 

the various options with your flight 

surgeon or aviation medical officer.

I would also recommend checking 

with the military pharmacy (if 

available) at your location before 

purchasing from your local drug 

store. Some military pharmacies 

have non-sedating antihistamines 

on their formulary. Also, I will take 

this opportunity to mention the fairly 

new TRICARE Mail Order Pharmacy 

program. While non-prescription, 

over-the-counter medications are not 

available through the TMOP, it is an 

excellent means of obtaining your 

Vaccines

— Continued from Page 5

non-emergent, routine medications 

stateside and overseas. You can 

get up to a 90-day supply for 

minimal co-pay. You can find more 

information on Tricare Mail Order 

Pharmacy program at 

http://www.tricare.osd.mil/pharmacy/

tmop.cfm. ■

Cmdr. Gene DeLara, Medical Service 

Corps, U.S. Navy, serves as the medical 

planner in the Deployment Health Support Directorate. He has a Doctorate 

of Pharmacy and a Masters of Business 

Administration. DeLara is both a pharmacist and medical planner. holding the 

1805 Plans, Operations, and Medical 

Intelligence specialty code.

leet Hospital (FH) 3 is testing a unique 

patient tracking system developed by 

Navy researchers. The Tactical Medical 

Coordination System (TacMedCS) is 

a wireless communication network 

designed for field use that captures and 

displays real-time casualty data. 

The system, originally designed for 

Fleet Marine Force (FMF) corpsmen to 

locate injured Marines during urban 

combat and document medical care, 

was reconfigured in record time to 

allow the fleet hospital to track patients 

moving through its facility. 

The original TacMedCS includes 

three components: a wearable plastic 

tag with an embedded electronic chip 

to store individual medical information; 

a palm-sized scanner to electronically 

read and write to the chip, and a central 

server with a database and a digital 

map display of the operational areas. 

With four years of research and 

multiple field trials during Marine 

Corps exercises to its credit, the 

research team from the Naval 

Aerospace Medical Research 

Laboratory, Pensacola, Fla., headed by 

Chief Hospital Corpsman Michael E. 

Stiney, already had the chips, scanners 

by doris ryan

bureau of medicine and surgery

FH-3 Tests Patient Tracking System In 

and server needed by FH-3. Instead of 

tags, the fleet hospital wanted patient 

wristbands, an easy task for the team 

and their civilian partners. The real 

obstacle was rewriting the software 

to capture the information the fleet 

hospital required. 

“We were asked to modify the 

TacMedCS system, and we did,” said 

Stiney, a cardiovascular technologist 

and FMF corpsman. In just one week, 

the team deployed 800 wristbands, 

a wireless network complete with 

relays and 

antennas, 

a laptop 

with the 

database, 

five 

scanners and a server.

The point man for the test is Lt. 

David Everhart, nursing informatics 

officer with FH-3. Everhart explained 

how TacMedCS is being used at the 

fleet hospital. 

The hospital receives patients 

primarily from forward surgical units 

and also serves as the “community 

hospital” for the region of operation. 

The patient administrative staff 

assembles charts for each patient, which 

includes a TacMedCS wristband. The 

casualty receiving corpsman scans 

the patient’s wristband, injuries and 

treatments are documented, and 

the patient is then moved to one 

of the three wards, the Operating 

Room, or the Intensive Care Unit. 

Movement through the fleet hospital 

is recorded and tracked by scanning 

the wristband. When the patient 

leaves the fleet hospital the final 

disposition is electronically written to 

the wristband.

FH-3 is a 500-bed level three 

facility with modular capability. For 

Operation Iraqi Freedom, the facility 

was configured to a 

116-bed expeditionary 

medical facility that 

included a casualty 

receiving unit, an 

operating room, three 

inpatient wards, and an intensive 

care unit. Ancillary services included 

laboratory, radiology and pharmacy 

suites.

“From a beta test standpoint, I feel 

that this has been very successful. 

Although we experienced some 

software problems initially, we have 

the system in place and working as 

anticipated. As a real-time patienttracking device, TacMedCS has 

proven it’s worth. The technology 

has enormous potential in my 

opinion. As these data travel with 

— Continued on Page 18

“As a real-time patient-tracking 

device, TacMedCS has 

proven it’s worth.”
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

I

American Legion 

Reaches Out To 

Families During 

Deployments

to shoulder this 

burden alone.

“The Family 

Support Network 

was not created 

to replace existing 

Department of 

Defense support 

programs, but 

rather to augment 

them and ensure 

that no family falls through the cracks. 

With 15,000 [American Legion] Posts, 

we have a lot of resources available 

at the local level ready to help our 

military family members in need.”

In 1990, the unprecedented 

mobilization of thousands of National 

Guard and Reserve units to support 

Operations Desert Shield and Desert 

Storm caught many of these military 

families unaware and unprepared 

to deal with shrinking income and 

juggling everyday responsibilities. 

Sometimes paychecks were lost or 

not forwarded to the family; this was 

especially true for National Guard and 

Reserve families. To meet the needs of 

these military families, the American 

Legion created the Family Support 

Network. Over the past 12 years, the 

Family Support Network has been 

providing assistance to thousands 

families of deployed servicemembers. 

This year alone, the Family Support 

Network has responded to more 

than 1,000 calls for assistance and 

information from military family 

members.

“The calls we receive range from 

simple requests for information to 

mowing the lawn to transportation 

assistance,” said Kees. “It’s just 

another way that we can support the 

troops and to show that we care.”

How the program works: 

Servicemembers and their families 

who need assistance can call the 

Family Support Network’s 

24-hour national toll-free hotline at 

(800) 504 - 4098. Information such 

as the name, address and telephone 

number of the caller and the reason 

for the call is collected. The call is 

then referred to the American Legion 

department or state in which the call 

originated. The departments relay 

the collected information to a local 

American Legion Post. The local Post 

contacts the family to see how they 

can provide any available assistance 

or refers the family to the 

appropriate agency. Additionally, 

families can submit an electronic 

by lisa a. gates

— Continued on Page 14

ncreased reliance on members of 

the National Guard and Reserves 

to support many of the recent 

operations and exercises overseas 

has, in some cases, caused a burden 

on family members left at home. For 

military family members needing 

an extra hand to help with everyday 

household chores — mowing the 

lawn, doing car and home repairs, 

cooking and caring for children 

— assistance may be as close as their 

nearest American Legion Post.

“The American Legion created the 

Family Support Network to help those 

families who are juggling finances, 

need the family car fixed or other 

home repairs or who needs someone 

to help with the grocery shopping,” 

said Jason Kees, program coordinator 

for the American Legion’s Family 

Support Network. 

“The men and women [serving 

in the military] are making a great 

sacrifice for our country and so are 

their families. The American Legion 

stands committed in our efforts to 

ensure that these families don’t have 
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

request to the Legion’s Web site 

at http://www.legion.org or send 

an e-mail message to familysupport@

legion.org to request assistance. E-mail 

messages should include the name, 

address and a telephone number 

where the family member can be 

reached and the type of assistance 

needed.

“Some of our posts are large while 

others are small, but [each] can offer 

help in some form or another,” said 

Kees. “Sometimes it’s just knowing 

where to call. Posts that don’t have 

the resources often act as a starting 

point for families to get the assistance 

they need.” 

The response to the Family 

Support Network has been 

overwhelming, said Kees. Since 

Sept. 11, 2001, there has been a 

tremendous outpouring of people 

wanting to know how and what 

they can do to support the troops. 

“It seems few truly understand 

how precious this type of support is 

to our men and women in uniform,” 

said Ronald F. Conley, the American 

Legion National Commander.

Another program, said Kees, which 

goes hand-in-hand with the Family 

Support Network, is the Temporary 

Financial Assistance.

“For families of eligible veterans 

with minor children, the American 

Legion can help meet the basic needs 

of shelter and food,” said Kees. 

The Family Support Network 

and Temporary Financial Assistance 

programs are just two examples of 

support the American Legion offers 

families of military personnel. The 

American Legion established the 

September 11 Memorial Scholarship 

program to ensure children of active 

duty personnel killed in the 

Sept. 11, 2001, terrorist attacks or while 

serving in support of Operations 

Enduring Freedom and Iraqi Freedom 

have the opportunity for higher 

education. 

To learn more about the Family 

Support Network, the Temporary 

Financial Assistance program, the 

September 11 Memorial 

Scholarship and other programs, 

go to the American Legion’s Web 

site, http://www.legion.org.

In response to the overwhelming 

requests from the public about how 

to support the troops, the American 

Legion launched a new section on 

their Web site to answer that question. 

The new section called “Support Our 

Troops” offers several suggestions 

of ways to reach out to U.S. 

servicemembers and their families.

The American Legion was 

chartered by Congress in 1919 as 

a patriotic, mutual-help, war-time 

veterans organization. It has nearly 

three million members in some 

15,000 American posts worldwide. 

These posts are organized into 55 

Departments — one each for the 50 

states, the District of Columbia, 

Puerto Rico, France, Mexico and 

the Philippines. ■

Legion

— Continued from Page 13

by capt. don kerr

379th air expeditionary wing public affairs

aybe more than any other aircraft in the 

coalition inventory, the F-15E Strike Eagle 

used new tactics in combat to neutralize enemy 

forces and provide ground troops 

with air support.

Strike Eagle aircrew often took off on 

missions not knowing their specific targets 

or their coordinates. But they did know their 

mission: to take out key enemy military 

infrastructure and also provide critical 

close-air support against enemy troop 

concentrations on the ground.

First Lt. Julie Ayers, a 336th Expeditionary 

Fighter Squadron weapons system officer, 

deployed to an air base in Southwest Asia 

supporting combat operations.

Arriving as an aviator with less than two 

years in the back seat of the F-15E, Ayers now 

has as much or more combat experience than 

50 percent of Strike Eagle navigators. However, 

being a junior officer and being a woman has 

not overwhelmed Ayers.

“When I think about my personal 

contribution, it’s really a drop in the bucket,” 

she said. “Compared to the overall number 

of sorties flown every hour of every day of 

every week, my contribution was small. Being 

so young, I’m just glad I got the opportunity 

to be a part of this.”

While she takes pride in being a role 

model for women, that has no bearing on her 

responsibilities or performance when flying.

“I don’t ever think about it when I’m flying,” 

said Ayers. “[Women] get treated exactly the 

same in the jet. There are certain tasks for the 

pilot to do and certain tasks for the WSO to do, 

and they are not gender-specific. When the 

pilot needs you, he 

doesn’t have time to think about whether or not 

you’re a woman.” ■

U.S. Air Force photo by Master Sgt. Terry L. Blevins

First Lt. Julie Ayers, a 336th Expeditionary Fighter Squadron 

weapons system officer, arrived in Southwest Asia with less 

than two years in the back seat of the F-15E Strike Eagle. 

Female F-15E WSO 

Talks Combat
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

R

T

research

by karen fleming-michael 

standard staff writer, fort detrick, md. 

adiologists’ being able to access 

medical images without being in a 

hospital is commonplace in civilian 

medicine, and now the military has 

made teleradiology systems standard 

for even the most remote locations. 

First used by the Army in early 1991 

during the Gulf War, teleradiology 

subsequently deployed to Somalia, 

Haiti, Bosnia, Kosovo, Hungary, Navy 

ships and, most recently, Afghanistan 

and Kuwait.

“The technology today is so 

advanced that a clinic sending exams 

electronically thousands of miles away 

provides the same image quality as 

the images coming from their own 

in-house radiology department,” 

said Tom Lewis, who addresses 

teleradiology issues for the Air Force 

Medical Logistics Office. 

In large part, the exodus of 

Teleradiology Answer 

To Shortfall In Military 

Radiologists 

radiologists from the military has 

fueled the need for teleradiology 

systems. Over the next few 

years the Army expects to lose 

approximately 30 percent of its 

radiologists; the Air Force, 50 

percent; the Navy, 20 percent. 

“In four years [from 2002 to 

2005], the Army is projected to 

lose 33 [of its 113 radiologists] 

with no guarantee of 

replacements in sight,” said Bob 

De Treville, the program manager 

for Army teleradiology initiatives 

at Fort Detrick. (The outlook 

may not be quite so bleak for the 

Army. Col. James Breitweser, the 

radiology consultant, said the 

projected 

losses don’t take into account 

the continued graduation of 

radiology residents.) 

“Radiologists are in high demand 

everywhere,” said Chris Riha, a clinical 

engineering consultant for the Army’s 

he Department of Defense has a new 

online tool that serves as both a medical command and control center and 

medical surveillance system. The Joint 

Medical Workstation is one of 

the latest technological advances employed during Operation Iraqi Freedom. It allows commanders and medical planners to monitor the physical 

well being of their servicemembers and 

medical treatment facilities capabilities. 

The information collected can also be 

used to look for health trends and data 

analysis.

Theater commanders, joint task force 

commanders and medical planners 

New DoD Computer System Allows Commanders 

To Monitor Health of Troops In The Field

by melissa burslie

teleradiology program at 

Fort Detrick. “Their counterparts in 

civilian sectors are among the 

highest income group of practicing 

physicians.” For example, recent 

postings on Radiology Jobs Online 

feature positions that offer radiologists 

identified a need for one system that 

could compute and analyze information from the military services’ medical surveillance tools already in place. 

Several organizations, in conjunction 

with the Deployment Health Support 

Directorate, worked together and 

created the Joint Medical Workstation, 

also known as JMeWS, to meet that 

need. The Web-based workstation has 

been functional since January 2003 

and is currently being used by the 

United States Central Command. 

“With this Joint Medical Workstation, we are now able to provide a 

real-time medical snapshot of what is 

going on in a specific theater of operation down to the unit or joint task force 

level,” said Anthony DeNicola, Deployment Health Support Directorate’s 

program manger, Information, Technology and Security. “This information 

can then be used to locate, coordinate 

and provide the best care available to 

the servicemembers on the ground in a 

deployment situation.”

This joint compilation of data allows 

users to view information such as medical treatment facility location, equipment, supplies, blood and personnel. 

Capability reports generated from the 

data allow leaders to make better informed decisions about medical issues.

— Continued on Page 19

— Continued on Page 16
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

The workstation is designed with 

the ability to be customized by the 

user and has a variety of ways to show 

information quickly and easily. Some 

of these include geographical maps and 

color-coded charts and tables. For example, with one click on a map, a user 

can find out where the nearest orthopedic surgeon is located in theater or how 

many units of blood are in the closest 

medical treatment facility.

“All of the information collected 

is stored in a classified environment 

and is available through the classified 

Internet,” said DeNicola. “Once the 

patient information is extracted and 

declassified, it will be shared with 

the Department of Defense electronic 

medical records programs for archival 

and further analysis as needed.”

The second function of the Joint 

Medical Workstation is medical surveillance. Each treatment facility using 

this system submits a daily record of its 

patient encounters. These records are 

collected and give JMeWS the ability to 

show real-time patient status. If a treatment facility can’t submit the entire 

patient record, it submits a disease and 

non-battle injury report to indicate the 

number of patient visits to that particular facility. Data analysis tools then 

use the data derived from the patient 

records and disease and non-battle 

injury reports to determine trends and 

alert for spikes in specific areas. If the 

surveillance tool alerts for a spike, the 

command surgeon can investigate further by looking into individual patient 

records for particular symptoms. 

A real-time example of the ability 

to look at spikes occurred during the 

Severe sand and wind storm hit this forward 

deployed location in Southwest Asia. Conditions make it almost impossible to work outside. 

Sandstorms often make work difficult for airmen 

in the region. Despite the challenge, aircraft from 

the base still flew combat sorties in support of 

Operation Iraqi Freedom. 

U.S. Air Force photo by Master Sgt Terry L. Blevins

sandstorms in Iraq where troops were 

supporting Operation Iraqi Freedom. 

At the height of the sandstorms, 

JMeWS users could see the expected 

increase of respiratory complaints. 

As the sandstorms receded, so did the 

numbers of respiratory complaints 

from the personnel in theater. If those 

complaints had not decreased, further 

appropriate medical measures could 

have been taken. If time-specific medical information is needed for future 

analysis, it is electronically stored and 

available for researchers.

“The Department of Defense and 

Deployment Health Support Directorate continue to find ways to protect the 

health of the servicemembers and their 

families,” said DeNicola. “The Joint 

Medical Workstation ensures medical 

providers and military planners have 

the real-time information they need in 

any situation.”

Soon the Department of Defense will 

expand the JMeWS program to include 

additional major commands. Collecting and providing accurate medical 

information both in theater and after 

a deployment are part of the total 

Force Health Protection program. ■

Workstation

— Continued from Page 14

day or two. That reintegration is just a little bit too fast. In some 

cases, it could be jarring.” ■

Editor’s Note: If you feel the need to talk to someone about 

your deployment experiences or need information on where 

to seek physical and mental care, there are several resources 

available.

Many family support centers on installations as well as 

chaplains and other clergy members in your local communities 

provide one-on-one counseling and group sessions with 

licensed, professional counselors. Mental health services that 

are available through your TRICARE medical benefits are also a 

resource to call if you need them. Log on to the TRICARE Web 

site at http://www.tricare.osd.mil .

The Deployment Health Clinical Center at Walter Reed Army 

Medical Center joins with veterans, their families and their 

providers in an effort to find answers, improve health care and 

enhance quality of life after military deployments. You can 

reach them by calling toll-free (866) 559 – 1627 or on the Web at 

http://www.pdhealth.mil

Another resource is the Direct Hotline for Servicemembers, 

Families and Veterans where contact managers are able to assist 

in answering deployment-related questions. You can call the 

toll-free hotline number (800) 497 – 6261 

Monday through Friday from 9 a.m. to 9 p.m. Eastern Standard 

Stress

— Continued from Page 11

• Go slowly — don’t try to make up for lost time 

• Accept that things may be different 

• Talk with each other about your experiences 

• Take time to become reacquainted 

• Accept that your partner may be different 

• Remember that intimate relationships may be 

awkward at first 

• Tone down your fantasies — reality may be 

quite different 

• Communicate openly with your partner and family 

• Reassure your children — change often frightens them 

• Plan on family activities, but be flexible 

• Set aside quality time with each of your children 

• Plan for visits from your extended family 

• Curb your desire to take control

Homecoming Tips

Time. ■
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

healthbeat

A

re the bones in your body strong and 

healthy? If not, it could be a sign of 

osteoporosis.

Osteoporosis is defined as a disease 

in which bones become fragile and are 

more likely to break, according to the 

National Osteoporosis Foundation. 

Although there is no cure for 

osteoporosis, this debilitating disease 

is preventable, and treatable if you 

already have it.

Medical statistics show that an 

estimated 44 million Americans are at 

risk for this disease. Approximately 

10 million persons currently suffer 

with osteoporosis, and it is projected 

that 34 million individuals have low 

bone mass, making them highly 

susceptible to developing the disease. 

It also accounts for more than 1.5 

million fractures annually, most 

commonly in the hip, wrist, spine 

and ribs.

Many people think of this disease as 

an older person’s disease; however, it 

can develop at any age, and in people 

Make No Bones About 

by aveline v. allen

bureau of medicine and surgery public affairs

of all ethnic backgrounds. At least 80 

percent of women are affected by it, in 

comparison to 20 percent of men.

Although these numbers may be 

shocking, there are certain risk factors 

associated with this disease. The 

National Osteoporosis Foundation 

reports some of these include current 

low bone mass, a family history of 

osteoporosis, low lifetime calcium 

intake, cigarette smoking, excessive 

use of alcohol and an inactive lifestyle. 

“People who are at highest risk 

for osteoporosis are women who 

weigh less than 126 pounds, those 

persons who have a family history 

of osteoporosis or a fragility fracture, 

those who are current smokers, 

and people who have had a prior 

fracture,” said Cmdr. Amir Harari, 

head of the endocrinology division at 

Naval Medical Center San Diego.

Also referred to as the silent 

disease, osteoporosis has no 

symptoms associated with it, mainly 

because bone loss happens without 

any observable symptoms, according 

to the National Osteoporosis 

Foundation. Medical sources show 

A

Put Your Foot Down In The Right 

U.S. Air Force photo by Airman 1st Class Dallas Edwards

INCIRLIK AIR BASE, Turkey -- Lt. Col. Rod 

Matte, executive officer to the Operation 

Northern Watch commanding general, completes 

his goal of running 1,000 miles while deployed. 

by OS2 wendy kahn

national naval medical center 

need for surgical intervention,” says 

Lt. Cmdr. Alberto Rullan, service 

chief of podiatry and specialty leader — Continued on Page 18

ccording to statistics, about 75 percent 

of Americans will experience foot 

problems at some point during their 

life. 

Problems such as bunions, neuroma 

[pinched nerve] and improper foot 

hygiene cause foot pain, which can 

limit freedom and mobility in walking 

or any sports activity. 

The discipline of podiatry involves 

the medical and surgical treatment 

of all foot and ankle disorders. At 

the National Naval Medical Center 

in Bethesda, Md., the podiatry clinic 

offers a full scope of treatment from 

conservative care to invasive care.

“Conservative care is given for 

mild strains and sprains without the 

many persons don’t know they have it 

until their bones become so weak that 

any sudden movement, such as a strain, 

bump or fall, causes them to have a 

fracture.

“In women, the lifetime risk of an 

osteoporotic fracture is 40 percent,” said 

Harari. “This is greater than the risk of 

breast, endometrial and ovarian cancer 

combined.” 

However, people can prevent this 

disease by taking certain steps. One 

preventable measure is to have a bone 

density test, which according to the 

National Osteoporosis Foundation, 

can do three things: detect a potential 

fracture before it occurs, predict your 

chances of getting fractures in the 

future, and determine your rate of bone 

loss. 

Other preventable measures include 

creating and maintaining a diet rich 

in calcium and vitamin D, doing 

weight-bearing exercises, not smoking, 

lessening your alcohol consumption, 

and if prescribed, taking necessary 

medication to treat the disease.

Medical experts suggest, depending 

of podiatry for the Navy’s Bureau of 

Medicine and Surgery. “Treatment 

for a serious injury usually involves 

immobilization in a cast or splint until 

the servicemember can return to full 

duty or as close to full duty.” 

With mild sprains, patients are treated 

with rest, ice, compression and elevation 

also known as RICE. In both cases, they 

refrain from any activity until healed.

For some patients who have more 

severe foot and ankle problems, surgery 

or invasive care may be the only choice 

of treatment. Surgical treatment usually 

involves bunion deformities, torn 

ligaments and stress fractures. In the 

case of stress fractures, a screw, plate or 

a combination of surgical hardware is 

inserted into the foot to repair the injury.

The old adage, “the right tool for the 

right job,” is true for achieving optimal 

— Continued on Page 18
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

the patient, an entire medical history 

could be assembled and stored on the 

wristband,” Everhart added.

What is the next step? 

According to Stiney, “We are going 

to capitalize on the lessons learned 

from this experience. This is not a 

100 percent completed system yet, so 

we are going to take the information 

gathered by all the users over there and 

fine-tune the system to create a better 

product. 

“I think we will have a final 

product ready in a year. TacMedCS 

will be adaptable to requirements: 

preventive medicine, trauma treatment, 

casualty evacuation and humanitarian 

assistance. Whatever Navy medicine’s 

requirements are, we will deliver.” ■

U.S. Navy photo by Chief Journalist Al Bloom

Hospital Corpsman 2nd Class Sara Beishir and a crewmember of an Army UH-60 Black Hawk helicopter transfer one of the more than 500 patients seen by Fleet Hospital Three staff since the first 

Navy Expeditionary Medical Facility set up in a combat zone and started accepting patients on 

April 1. FH-3’s surgical capabilities range from ear, nose and throat and neurosurgery to orthopedics 

and ophthalmology. 

Patient Tracking

— Continued from Page 12

on a person’s age, an acceptable 

calcium level would be between 1,000 

and 1,300 milligrams per day. You 

can do this by eating calcium-rich 

foods, such as cheese and broccoli, and 

drinking low-fat milk. Also, explore 

food choices that already have calcium 

in them, such as some orange juice, 

cereals and breakfast bars.

performance and minimizing injury. 

While Rullan does not promote any 

particular brand of shoes, he does 

suggest the following guidelines for 

buying shoes.

The type of terrain and activity an 

individual chooses will determine the 

type of shoe. For the most part, a good 

running shoe should have a wide-heel 

base. The wider the heel base, the more 

stable the heel is when it comes into 

contact with the ground. Narrow heelbase shoes can cause ankle sprains.

Also, a good running shoe will 

incorporate a rocker bottom (curved 

bottom) into the forefoot, so there is less 

energy expenditure when running. A s 

a result, the exercise becomes amenable 

to conservation of energy and reduces 

wear and tear on the joints, according 

to Rullan. 

With respect to shoe size, it is best 

to buy shoes at the end of the day. In 

this regard, one can fit the shoe to the 

foot size because the feet are maximally 

swollen, which avoids the purchase of 

an ill-fitting shoe. 

Rullan says he discards the myth, 

“Give yourself time to break in the 

shoe.”

In the case of diabetic people, for 

example, the process of “breaking in a 

shoe” will bring more serious problems, 

such as injuries from shoes digging into 

their feet. Infection then sets in the foot 

because of breaks in the skin, which 

will cause circulation problems. Rullan 

emphasizes that the ideal situation is to 

buy a shoe that fits right from the very 

beginning. 

The following tips are guidance to 

reduce the risk of foot and ankle injury:

Make slow increments when 

running and gradually build up to 

longer distances if your body is not 

accustomed to running.

Stretch before and after activity to 

loosen muscles and tendons.

After satisfying the calcium 

requirement, you can get your 

Vitamin D from major food sources, 

such as dairy products, egg yolks, 

saltwater fish and liver, according to 

National Osteoporosis Foundation. 

As you maintain the nutritional 

aspect, don’t forget to exercise. 

Examples of weight-bearing exercises 

include walking, jogging or dancing.

According to the National 

Osteoporosis Foundation, building 

strong bones, especially before the 

age of 30, can be the best defense 

against developing osteoporosis, and 

a healthy lifestyle can be very 

important for maintaining strong 

bones.

To learn more about osteoporosis 

and its effects on the body, go to the 

National Osteoporosis Foundation’s 

Web site at http://www.nof.org/ ■

Bones

— Continued from Page 17

Right Shoe

— Continued from Page 17

Know the terrain.

Listen to your body. Don’t stick to 

the “no pain, no gain” phrase when not 

comfortable with activity. Once your 

body has reached its physiologic limit, 

stay at that limit.

Have proper shoe gear for running.

Supplement exercise routine with 

other activities such as swimming, 

weight training, cycling and other 

cardiovascular activities that will 

minimize joint injury.

No matter what the sport, it’s always 

a challenge in fitting the right shoe to 

the foot. The style of shoe, where they 

are made and the type of shoe gear 

bought all influence the size. So, “let 

your fingers do the walking,” but let 

your feet do the running in the 

right pair of shoes. ■
http://deploymentlink.osd.mil • summer 2003 Deployment Quarterly

$200,000 to $400,000 as annual base 

pay. 

To retain radiologists, the Air 

Force, Army and Navy are focusing 

on making radiologists’ jobs and 

lives easier. 

“They have to pull incredible 

schedules — after hours, on call 

—because someone’s got to read the 

images, and quickly,” De Treville 

said. 

With teleradiology, it allows them 

to be virtually anywhere reading 

images — whether the images come 

from a nearby base or across the 

ocean from a tent — via secure, 

high-speed connections. 

In addition to reducing the 

radiologist’s stress, teleradiology 

improves service to patients. 

Facilities that do not have staff 

radiologists can obtain radiology 

interpretations on the same day the 

images are taken. The old system, in 

contrast, required x-ray techs to pack 

films in boxes and mail them away to 

be read, a process that routinely took 

up to 21 days in remote locations in 

Korea and Germany.

In March 2002, for example, 

CT images for a soldier in Bosnia 

diagnosed with a brain tumor were 

reviewed first by neurosurgeons 

at Landstuhl Region Medical 

Command in Germany. Later that day 

neurosurgeons at Walter Reed Army 

Medical Center saw the images and 

consulted with Landstuhl on how 

best to treat the patient, whom they 

evacuated to Walter Reed. 

Today’s systems are fairly 

straightforward, Riha said. They 

contain an x-ray machine to expose 

a reusable film-like phosphor coated 

plate, a computed radiography scanner 

to extract the medical image in digital 

format from the plate, a specialized 

server to store and distribute the 

images and laptops or PCs to view and 

interpret images. 

“You can deploy the system in a 

hardened plastic case and set it up in 

a tent or shelter,” Riha said. 

After the equipment is set up in a 

remote location, all that’s left for the 

x-ray tech to do is determine the best 

way to get the encrypted image to a 

radiologist. Images can be burned on 

a CD and sent along with the patient, 

or if space-based wide area network 

bandwidth is available, the server 

can bounce images 23,000 miles up 

to a satellite, which in turn bounces 

them to Landstuhl to the radiologist’s 

computer. Images that need to go from 

Germany to stateside facilities, like 

the Walter Reed Army Medical Center, 

are typically sent via terrestrial, (for 

example, submarine) cable. 

“When there’s a patient being 

medically evacuated, the patient’s 

Radiology

— Continued from Page 15

information is sent through the system, 

so the doctors can get prepared before 

the patient arrives,” said Liz Spangler, 

who works on network security for the 

Army’s system. 

Though the images can be large 

— a three-image series of chest xrays can be 30 megabytes — images 

seemingly speed from sender to 

receiver. With today’s wide-area 

network connections, images “can 

traverse an entire continent within a 

matter of seconds to a few minutes, so 

there really isn’t a noticeable time lag 

in sending and receiving teleradiology 

exams,” Lewis said.

Often used so remote locations 

can “reach back” to a fixed facility 

to get radiology or other medical 

support, teleradiology also allows 

those facilities to reach forward for 

help. When Williams was deployed in 

Bosnia and found he had spare time, he 

used the system to read images from 

Fort Bragg, in effect becoming the oncall radiologist.

“Because of the time difference 

in overseas locations, the deployed 

radiologist can get the image, read 

it and return it with a report during 

normal work hours in their time zones, 

when radiologists back home might be 

asleep,” Riha said. ■

Personnel from the 615th Air Mobility 

Operations Group lay concertina wire to 

secure the perimeter of a forward-deployed 

location in Iraq supporting Operation Iraqi 

Freedom.

U.S. Air Force photo by Senior Airman JoAnn S. Makinano

All Wound Up
Deployment Quarterly summer 2003 • http://deploymentlink.osd.mil

other resources

Air Force Association

1501 Lee Highway

Arlington, VA 22209-1198

Phone: (800) 727 - 3337

http://www.afa.org

American Legion

1608 K St., NW

Washington, DC 20006

Phone: (202) 861 - 2700

http://www.legion.org

American Red Cross

17th & D Streets, NW

Washington, DC 20006

Phone: (202) 639 - 3520

http://www.redcross.org

American Veterans

4647 Forbes Blvd.

Lanham, MD 20706

Phone: (877) 726 - 8387

http://www.amvets.org

Association of the U.S. Army

2425 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 336 - 4570

http://www.ausa.org

Department of Veterans Affairs

810 Vermont Ave., NW

Washington, DC 20400

Phone: (202) 273 - 4300

http://www.va.gov

Disabled American Veterans

807 Maine Ave., SW

Washington, DC 20024

Phone: (202) 554 - 3501

http://www.dav.org 

Enlisted Association of 

the National Guard

1219 Prince St.

Alexandria, VA 22314

Phone: (800) 234 - 3264

http://www.eangus.org

Fleet Reserve Association

125 N. West St.

Alexandria, VA 22314-2754

Phone: (703) 683 - 1400

http://www.fra.org

Marine Corps Association

715 Broadway St.

Quantico, VA 22134

Phone: (866) 622 - 1775

http://www.mca-marines.org

Marine Corps League

8626 Lee Highway, #201

Merrifield, VA 22031

Phone: (800) 625 - 1775

http://www.mcleague.org

National Association for 

Uniformed Services

5535 Hempstead Way

Springfield, VA 22151

Phone: (800) 842 - 3451

http://www.naus.org

National Committee for Employer 

Support of the Guard and Reserve

1555 Wilson Boulevard, Suite 200

Arlington, VA 22209-2405

Phone: (800) 336 - 4590

http://www.esgr.org

National Guard Association

of the United States

1 Massachusetts Ave., NW

Washington, DC 20001

Phone: (202) 789 - 0031

http://www.ngaus.org

Naval Reserve Association

1619 King St.

Alexandria, VA 22314-2793

Phone: (703) 548 - 5800

http://www.navy-reserve.org

Navy League

2300 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 356 - 5760

http://www.navyleague.org

Non Commissioned 

Officers Association

225 N. Washington St.

Alexandria, VA 22314

Phone: (703) 549 - 0311

http://www.ncoausa.org

Reserve Officers Association

1 Constitution Ave., NE

Washington, DC 20002

Phone: (800) 809 - 9448

http://www.roa.org

Military Officers Association 

of America 

201 N. Washington St.

Alexandria, VA 22314

Phone: (800) 245 - 8762

http://www.moaa.org

Veterans of Foreign Wars

200 Maryland Ave., NE

Washington, DC 20002

Phone: (202) 543 - 2239

http://www.vfw.org

Vietnam Veterans of America

8605 Cameron Street, Suite 400

Silver Spring, MD 20910-3710

Phone: (301) 585 - 4000

http://www.vva.org

By Phone 

Direct Hotline for Servicemembers, 

Veterans and Families	 	 	

	 (800) 497 - 6261

Deployment Health Clinical Center

(866) 559 - 1627

Department of Veterans Affairs

	 (800) 827 - 1000

VA Gulf War Registry	 	 	

	 (800) 749 - 8387

VA Benefits and Services	 	

	 (877) 222 - 8387

On the Web

Department of Defense

http://www.defenselink.mil

Department of Veterans Affairs

http://www.va.gov/

DeploymentLINK

http://deploymentlink.osd.mil

GulfLINK

http://www.gulflink.osd.mil

TRICARE

http://www.tricare.osd.mil/

re- guide